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Nocturnal Arrhythmias Across a Spectrum of Obstructive and Central Sleep-Disordered Breathing in Older MenOutcomes of Sleep Disorders in Older Men (MrOS Sleep) Study
Reena Mehra, MD, MS;
Katie L. Stone, PhD;
Paul D. Varosy, MD;
Andrew R. Hoffman, MD;
Gregory M. Marcus, MD, MAS;
Terri Blackwell, MA;
Osama A. Ibrahim, MD;
Rawan Salem, RPSGT;
Susan Redline, MD, MPH
Arch Intern Med. 2009;169(12):1147-1155.
Background Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men.
Methods A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed.
Results An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19-3.89) and CVE (OR, 1.43; 95% CI, 1.12-1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95% CI, 1.61-4.47) than CVE (OR, 1.27; 95% CI, 0.97-1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23-2.14) compared with the lowest quartile.
Conclusions In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.
Author Affiliations: Center for Clinical Investigation (Drs Mehra and Redline and Ms Salem) and Department of Medicine (Drs Mehra, Ibrahim, and Redline), Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Medicine, California Pacific Medical Center Research Institute and the San Francisco Coordinating Center, San Francisco (Dr Stone and Ms Blackwell); Department of Medicine, Veterans Affairs Medical Center, San Francisco (Dr Varosy); Department of Medicine, University of California at San Francisco (Drs Varosy and Marcus); and Department of Medicine, Stanford University, Stanford, California (Dr Hoffman).
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